Correlates of suicidality among standard rating scales and the Columbia-Suicide Severity Rating Scale (C-SSRS) in adolescents undergoing transcranial magnetic stimulation

Abstract

Background: Suicide is a leading cause of death in adolescents and young adults.1 This study sought to examine correlations among suicide items of standard rating scales for depression and Columbia-Suicide Severity Rating Scale (C-SSRS)2 scores in adolescents participating in a transcranial magnetic stimulation study. Methods: This study examined data from adolescent patients (N=103) enrolled in a double-blind randomized control trial of transcranial magnetic stimulation (TMS). Total scores and respective individual items assessing suicidality from the Hamilton Depression Rating Scale (HAM-D)3, Montgomery-Asberg Depression Rating Scale (MADRS)4, and Children’s Depression Rating Scale-Revised scale (CDRS-R)5 were compared with C-SSRS total severity and total intensity scores using Pearson correlation coefficients at the end of acute treatment. Results: The suicidality item of the HAM-D scores showed a positive association with C-SSRS total severity and intensity scores at the end of acute treatment for ITT sample (n=103) (r = 0.83; p-value= <0.0001, r = 0.86; p-value=<0.0001), respectively. Similarly, associations were demonstrated with the CDRS-R Item 13 scores and the MADRS scores. Conclusions: Accurate and reliable assessments of suicidality are an ongoing challenge for clinical trials and practice. Suicidality measures of HAM-D and CDRS-R correlated with the C-SSRS suicide assessment scale. These measures can potentially contribute to assessing suicidal risk and be helpful as an outcome measure to monitor treatment response in various clinical settings. Further studies should compare the sensitivity and specificity of suicidality items of HAM-D and CDRS-R. Conflicts of Interests: Dr. Croarkin has received research support from the National Institute of Mental Health, Magventure, Neuronetics, NeoSync, and Pfizer. He has received material support from and provided consultation to Myriad Neuroscience. He has consulted for Procter & Gamble Company. Dr. Elmaadawi receives research support from Duke University and the University of North Western. He receives research funding from Neurocrine, Inc, and Neuronetics. Dr. Aaronson has received research support from Compass Pathways and Neuronetics and serves as a consultant to LivaNova, Neuronetics, Janssen, Genomind, and Sage Therapeutics. He serves on speaker boards for Janssen and Sunovion. Dr. Holbert has received material support (equipment) from Neuronetics. He is also a speaker for Neuronetics. Dr. Demitrack is a consultant to Neuronetics, Inc. and a full-time employee of Trevena, Inc. Dr. Strawn has received research support from Allergan, Neuronetics, Otsuka, the National Institute of Mental Health, National Institute of Child Health and Development, and National Institute of Environmental Health Sciences as well as the Yung Family Foundation. He receives royalties from Springer Publishing and received honoraria from CMEology and Neuroscience Educational Institute. He receives royalties from UpToDate. Finally, he received material support from and provided consultation to Myriad Genetics, Intracellular Therapeutics, and the FDA. The other authors have no disclosures. Funding: This study was funded by Neuronetics, Inc.